Chronic kidney disease in the elderly Assessment and management

Background A reduction in estimated glomerular filtration rate (eGFR), and/or the presence of proteinuria, are the predominant manifestations of chronic kidney disease (CKD), which is common in the elderly population. Objective This article outlines the clinical significance of CKD in the elderly and summarises recently updated recommendations for its assessment, staging and management. Discussion Most elderly patients with CKD present asymptomatically. Despite this, it is clinically significant as it is one of the most potent risk factors for cardiovascular disease. Even modest reductions in eGFR are associated with an increased prevalence of CKD-related complications such as anaemia and hyperphosphataemia. Early detection is an important strategy and should include all three components of the kidney health check (blood pressure measurement, a blood test for serum creatinine and eGFR, and a urine test for albumin:creatinine ratio). Treatment is guided by the patient's stage of CKD, based on kidney function (eGFR) and kidney damage (degree of albuminuria), and control of blood pressure to recommended levels with appropriate medications. The majority of elderly patients with CKD will not ultimately require, or desire, renal replacement therapy and may be safely managed in general practice.